California Licensed Compliance Manager

Job Summary

To support Health Plan Risk Adjustment operations, the full-time remote California Licensed Compliance Manager will oversee compliance activities, manage coding audits, and ensure regulatory adherence while collaborating with clinical and operational teams.

Key responsibilities:

• Manage compliance activities and strategic initiatives by partnering with internal and external stakeholders
• Oversee coding validation, documentation review, and data-driven analysis to ensure accurate risk capture and coding integrity
• Develop and implement the annual coding audit plan in collaboration with reimbursement compliance teams

Required qualifications:

• Minimum six (6) years of medical coding experience
• Minimum three (3) years in a leadership role, with or without direct reports
• Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business, or related field, along with a minimum of eight (8) years of relevant experience
• Certified Coding Specialist from the American Health Information Management Association or Certified Professional Coder from the American Academy of Professional Coders
• Experience in health care compliance, operations, audit, or regulatory policy development